Under Trump, US debates a leader’s mental fitness as never before

Two books, one quoting White House insiders and the other by psychiatrists, have spurred discussion of a long-taboo subject regarding sitting presidents. It's about Trump, but also about whether the "Goldwater rule" against armchair diagnosis should still apply.

Yuri Gripas/Reuters

President Donald Trump speaks to the media after the Congressional Republican Leadership retreat at Camp David, January 6.

President Trump’s mental health has burst into public consciousness, following release of the explosive tell-all book “Fire and Fury” and Mr. Trump’s eye-popping Twitter response – in which he called himself a “very stable genius.”

The book, by journalist Michael Wolff, describes a chaotic White House riddled with infighting. In an interview on NBC’s “Today,” Mr. Wolff asserted that “100 percent of the people” around the president – including senior advisers and family members – question his intelligence and fitness for office.

But anyone who thinks the Trump presidency is on the ropes or that he’s about to be removed from office via the 25th Amendment to the Constitution – a topic Wolff claims White House aides discussed repeatedly – has another thing coming, analysts say. And, it can be argued, Mr. Trump may in fact come out on top when all is said and done, given the questions surrounding the reporting techniques used by Wolff, and factual errors in the book.

In addition, efforts by mental-health professionals to raise alarm bells about Trump’s stability may well backfire, as none have formally evaluated Trump. The American Psychiatric Association’s longstanding code of ethics prohibits drawing conclusions about a person’s mental state without an in-person examination.

“I think this all inoculates him,” says Steven Schier, a political scientist at Carleton College in Northfield, Minn., and co-author of a book on the first months of Trump’s presidency. “In other words, the more this stuff is out there, the less impact it probably has.”

“I’m not defending Trump,” Mr. Schier continues. “Even a casual view of his behavior does raise concerns, but it doesn’t mean he’s clinically [out of his mind].”

Besides Wolff’s book, a months-long effort by a Yale University psychiatry professor to sow alarm about Trump’s mental stability has added to the drumbeat of concern about his ability to function as president. The professor, Bandy Lee, published a book of essays last October by 27 mental-health practitioners who say their “duty to warn” the nation about Trump’s mental health supersedes “professional neutrality.”

But the nation has hardly reached the point where an effort to remove Trump from office via the 25th Amendment is even remotely feasible. The 25th Amendment, enacted in 1967, was a response to the assassination of President John F. Kennedy, which raised questions about the nation’s governance had Mr. Kennedy survived but in an incapacitated state.

The requirements for removing a president under the 25th Amendment are steep: The vice president and a majority of Cabinet members must make a “written declaration that the president is unable to discharge the powers and duties of his office.” Then a two-thirds vote by both houses of Congress is required to fulfill the transfer of power to the vice president.

‘Inoculated with his base’

On Monday, Wolff acknowledged on “CBS This Morning” that he did not interview Vice President Pence or any Cabinet members for his book. This admission throws cold water on his suggestion that the 25th Amendment is a viable option. Wolff’s book quotes White House staffers speaking frequently about the 25th Amendment. Wolff spent the better part of a year essentially as “a fly on the wall” inside the West Wing, at the invitation of now-former Trump aide Steve Bannon and current adviser Kellyanne Conway.

Wolff’s book, which burst into public view last week, was not what the Trump White House expected. But so far, it doesn’t seem to be hurting the president’s job approval ratings, still sitting at about 40 percent.

The flaws in Wolff’s book – which the author himself admits was produced hastily – have played into Trump’s narrative of a press corps eager to take him down, and that could help him survive this latest maelstrom.

“At least he’s going be inoculated with his base,” says Republican strategist Ford O’Connell. “He’s also probably going to get the benefit of the doubt among some right-leaning conservatives and potential independents in key states going forward,” particularly in the midterm elections this November.

Mr. O’Connell also sees a lot of the “mainstream media” angry that Wolff beat them to the punch. “I think they would have preferred to build the ‘Trump is nuts’ narrative over time, and now it could undercut their reporting and be a blessing for Trump,” he says.

Dr. Lee of Yale reportedly spent two days on Capitol Hill last month, meeting with more a dozen Democratic senators about Trump’s mental state.

From Lincoln to LBJ

If anything, one outcome is clear from both the Wolff book and Lee’s effort to raise alarm bells about Trump’s behavior: They have busted through the taboo that has kept public discussion of presidential mental health under wraps, at least while a president is still in office.

Throughout history, presidents have faced emotional and mental challenges, either following a family tragedy or under the strain of the job. Experts on the presidency describe the job as isolating; only the president himself knows what he is experiencing.

“Woodrow Wilson was sidelined in August 1914 by the death of his first wife. It took him a while to snap out of it,” says historian David Pietrusza. “When he did, he was seriously lovesick over courting his future second wife, Edith Bolling Galt. I'm not sure which situation was worse.”

President Abraham Lincoln, who lost two of his children, was reported to have suffered from depression. Kennedy was diagnosed with anxiety, and took heavy-duty prescription medication. Presidents Franklin Pierce and Calvin Coolidge both lost children, and dealt with depression.

Aides to Lyndon Johnson and Richard Nixon had to navigate both presidents’ serious psychological challenges.

As for Trump, “playing armchair psychiatrist/psychologist is a dangerous game, even when one knows the individual in question very well,” says Mr. Pietrusza in an email. “Playing it at a distance is like playing the lottery. Add a substantial dose of political self-interest, and the pastime becomes even less reputable.”

“Previously, the knock on Trump was that he was fascist," Pietrusza continues. "That proved to be incorrect. He was not a fascist. He was just Trump. Now, he is rumored to be mentally unfit as defined by the 25th Amendment or by some such reasoning process. He is, however, probably still just Trump.”

‘Goldwater rule’ at stake

On Friday, Trump will go for a physical exam at Walter Reed National Military Center. Typically, presidential physicals don’t include an examination of mental health. But when spokeswoman Sarah Sanders was asked last week if Trump’s physical would include mental health, she did not say either way.

In response to an interview request about psychiatrists’ comments on Trump, the American Psychiatric Association (APA) responded by providing a link to its web page on with the so-called “Goldwater rule.” The rule, instituted in the wake of Republican Sen. Barry Goldwater’s presidential campaign in 1964, was a response to a survey sent by Fact magazine to more than 12,000 psychiatrists, who were asked to assess Senator Goldwater’s mental health.

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The survey elicited some “harshly negative responses” by psychiatrists who had never met Goldwater, and in 1973, the APA instituted its rule forbidding members from commenting on the mental health of political candidates. Many of the responses were deemed to be tainted by the political views of the doctors.

Today, some psychiatrists argue that since non-physicians comment publicly on Trump’s mental state, the Goldwater rule binds medical professionals unfairly. And in the case of Trump, some feel a “duty to warn” the public about what they see as danger signs.

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